Dr. Mary Gardner is on the podcast to discuss the ethics of behavioral and economic euthanasia. We talk about what makes some euthanasia cases more ethically difficult than others, and the 4 types of euthanasia generally seen in practice:
1) Imminent Euthanasia
2) Non-Imminent Euthanasia
3) Non-Medical Euthanasia
4) Convenience Euthanasia
Dr. Gardner walks us through a series of challenging decisions and tells stories that bring her points to life. This is an outstanding episode that you will not want to miss!
LINKS
Lap of Love Pet Hospice: https://www.lapoflove.com/
GSD Shorthanded Virtual Conference: https://unchartedvet.com/gsd-shorthanded/
Dr. Andy Roark Exam Room Communication Tool Box Course: https://drandyroark.com/store/
What’s on my Scrubs?! Card Game: https://drandyroark.com/training-tools/
Dr. Andy Roark Swag: drandyroark.com/shop
All Links: linktr.ee/DrAndyRoark
ABOUT OUR GUEST
There is nothing better to Dr. Gardner than a dog with a grey muzzle or skinny old cat! Her professional goal is to increase awareness and medical care for the geriatric veterinary patient and to help make the final life stage to be as peaceful as possible, surrounded with dignity and support for all involved.
A University of Florida graduate (AND ANDY’S CLASSMATE!), she discovered her niche in end-of-life care and is the co-founder and CIO of Lap of Love which has over 300 veterinarians around the country dedicated to veterinary hospice and euthanasia in the home.
Dr. Gardner and Lap of Love have been featured in Entrepreneur Magazine, The New York Times, the Associated Press, The Doctors and numerous professional veterinary publications. She is co-author of the textbook “The Treatment and Care of the Veterinary Patient”, co-author of a children’s activity book focused on saying goodbye to a dog called “Forever Friend”, and the author of a book dedicated to pet owners “It’s Never Long Enough: A practical guide to caring for your geriatric dog”. Dr. Gardner also won VMX Small Animal Speaker of the year in 2020!
EPISODE TRANSCRIPT
This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.
Dr. Andy Roark:
Hey, guys. Before we get started, I just want to remind you that the Get Stuff Done Shorthanded virtual conference is coming October 6th through the 8th. I’m letting this now super early. This is an uncharted conference that is, it’s my baby. I love it. I’ve been very involved with it. I will be very involved with it going on. It is a very interactive conference. It is not sit and just have webinars on. This is small group, discussion group. We make a big chunk of the conference content on the first day of the conference, where we figure out what people want to do. And then we make that happen in the back part of the conference. It is very much for attendees by attendees. It is all about getting things done, when you’re shorthanded, when you’re feeling overwhelmed.
Dr. Andy Roark:
And I know that some of you guys are so anyway, I’m going to put a link down in the show notes, check it out below. I’d love to see you there. You just get signed up and then we’ll keep you posted and let you know when registration opens, but October 6th through the 8th, virtual conference. That’s all I got for you. I’m going to put a link in the show notes. Welcome everybody to, The Cone of Shame Veterinary podcast. I am your host, Dr. Andy Roark. Guys, I am here today with one of my best friends in the world, Dr. Mary Gardner. This is an interesting episode. It’s a long one for us. It’s about 40 minutes, Mary and I talk, but we talk about the morality and the ethics of euthanasia’s.
Dr. Andy Roark:
We talk about convenience euthanasia, and we talk about economic euthanasia, and we talk about behavioral euthanasia, like reactivity in pets or aggression, whatever people want to call it, or imagine it as. Things like that. But we talk a lot about the hard euthanasia cases. And guys, I took a lot away from this episode. I love Mary’s perspective. I think she’s so interesting. She’s an amazing storyteller, amazing lecturer, but she geeks me out. So you’re going to hear us talking over each other, probably. But you’re going to hear us tell a lot of stories, but man, this is a great episode. I’ll be listening back too, probably a couple of times. So anyway, guys, without further ado, let’s get into it.
Kelsey Beth Carpenter:
(Singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to The Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark:
Welcome to the podcast, Dr. Mary Gardner. Thanks for being here.
Dr. Mary Gardner:
Hi, Andy. Thanks for having me again.
Dr. Andy Roark:
I love having you on the podcast. People should know, you are one of my best friends-
Dr. Mary Gardner:
I know.
Dr. Andy Roark:
In the world, in real life. For those who do not know the one and only Dr. Mary Gardner, she is a co-founder of Lap of Love Pet Hospice, which is a behemoth of a company that… I’m looking at you in your office and you have your Entrepreneur Magazine that you were featured in up on the wall. It’s that level of success. You’re a veterinarian. You and I went to vet school together.
Dr. Mary Gardner:
Yes.
Dr. Andy Roark:
We graduated in the same class.
Dr. Mary Gardner:
Love it.
Dr. Andy Roark:
We sat together in the back of the room and yeah, we have been dear friends ever since you are one of the best lecturers in veterinary medicine in America. And I say that in all sincerity and you are genuinely a hilarious, funny person who I deeply enjoy talking to. So I’ll always love having you here. Thanks for being here.
Dr. Mary Gardner:
Same back. And I love it when I see you in my lectures, which is always fun.
Dr. Andy Roark:
Oh, yeah. I 100% come and sit in your… Honestly, let that be the high praise that it is. I go to conferences and I’m busy. I don’t sit in on a lot of lectures at big conferences, but I come and sit in on your lectures because you’re that good. And you should be really-
Dr. Mary Gardner:
I would sit in yours, but I can’t wait in the lines. Can I get a backstage… I want speaker assistant tag.
Dr. Andy Roark:
Oh, my face is red. That was well played. All right. Now that we’ve fluffed our pillows enough. Let’s let’s move on. Okay. So let me also, I bring up how much I love you and how we to joke together, because we’re doing a sensitive topic podcast, but it is in our nature too just to talk and to be honest, and sometimes you laugh because you don’t want to cry. And so people, what they should know going into this podcast is we’re going to talk about some heavy stuff, but you’ll probably hear us also be very matter-of-fact about it and go back and forth. If that’s upsetting, now is the time to delete this podcast and listen, instead to, I don’t know, whatever.
Dr. Mary Gardner:
Headspace. I don’t know.
Dr. Andy Roark:
Yeah.
Dr. Mary Gardner:
No, this is a very disclaimer, because I’ve gotten very nasty comments just on, oh, you smile while you’re talking about pet loss or you’re… And you laugh and things like that. So you just, you can’t make everyone happy. Right?
Dr. Andy Roark:
Well, I’ve gotten those too. They’re generally when pet owners are there. You know what I mean?
Dr. Mary Gardner:
Agreed.
Dr. Andy Roark:
If I do a YouTube video and it’s about anything that has to do with pain in pets. If I’m smiling about something, even if I take a side step and tell a funny story on the side, they’re like, how did you-
Dr. Mary Gardner:
How dare you.
Dr. Andy Roark:
How could you possibly tell a funny story while you’re talking about this? And again, I get it. I think anyone who’s been in vet medicine for some time has got some pretty good coping mechanisms.
Dr. Mary Gardner:
Yes.
Dr. Andy Roark:
And can compartmentalize pretty well.
Dr. Mary Gardner:
Pretty much.
Dr. Andy Roark:
I think that is a learned skill. So anyway, I thought of it early on. I was like, I better give that disclaimer, because I don’t plan to have a deep emotional conversation with Mary. And at the same time-
Dr. Mary Gardner:
We will.
Dr. Andy Roark:
I’m going to ask you some heavy stuff. All right. Okay, cool. So here’s what I’ve got for you. And this is not a specific case, but this is a general head space that I wrestle with a lot. Okay. So a couple of things that are happening here, and this may be too big to really get all the way into the way I want. I’m might have to get you back. So I’m looking at a couple of things here, right? So I’m looking at the rising cost of pet care, the inflation. So just take it off of that medicine, just be, man. Inflation is real. And salaries for vet professionals is going up, which is good. It needs to happen. But at some point there’s not a magic money tree, right? This is all coming around from somewhere. There’s private equity groups that are buying vet hospitals, and they’re not buying them out of the kindness of their heart.
Dr. Andy Roark:
These are investment properties and they’re expecting to make money off of them. And so I’m looking at a lot of things and saying, oh man, I’m seeing the cost of care going up and things that. And so I was thinking through, and I go, what does mean? Well, at some point, I think it might affect the behavior of pet owners. There may be people who don’t get pets if they can’t afford them. And I don’t like that. And I’m working with everybody else to try to figure out how to make that not happen. But one of the things we’ve seen in the past, and I also add into this, we very likely are heading into recession in this country. And what does a recession mean for pet care? Well, it means that some people can’t afford to do things they could have otherwise done. And so I always worry or wonder are these things going to come back around to things like economic euthanasia? And so that’s part of this.
Dr. Andy Roark:
The other part, so I think about that and go, well, what does that mean? And what is my role in this? When we talk about euthanasia and the other part is behavioral euthanasia. And these are sort of related and not related, but I had people come in and they say, “Well, I have this dog and he’s bitten three people in our house and never badly, but we can’t have this person or this pat that we can’t trust.” Or you have people who come in and they say, “This cat won’t stop peeing outside the litter box and we need to put them down.” And that’s the classic sort of behavioral euthanasia. Is a convenience, euthanasia sort of thing. And so, I put these things down and they’re different. I know that I’m giving you a lot of really different examples, which make this hard for you, but I’m someone who… I know. I want to make this real hard.
Dr. Mary Gardner:
I know.
Dr. Andy Roark:
You’re getting the master level interview here where I just ask you horribly terrible questions. So I put these things down because I am someone who thinks deeply on these sort of things. And in the practice, I like to have some sort of philosophical guidelines and they don’t have to be perfect, but where are the stepping stones where I put my feet? And I’ve struggled with these to even figure out what lens to sort of look through and say, are there different levels of euthanasia? Are there different kinds of euthanasia? Are there different morality, levels of euthanasia? Help me navigate that. And so I’m going to start with that big wide open question of, are there different kinds of euthanasia and are there different moralities in euthanasia? And how do you start to parse those things apart?
Dr. Mary Gardner:
Oh, okay. So yes, I do believe there’s different levels. And I think it’s hard for us to pillow our head at night for some of them. Then there’s some that we’re like, yep, we’re ready to do this. And then there’s also times where we want to do a euthanasia and an owner doesn’t want to do it yet. Right. They’re on denial island or just, they love their pet. They don’t want to say goodbye. So we break it down into four categories. The first type of euthanasia is the imminent-ish medical euthanasia. Right. So I say, ish. So you’ve got a dog that’s got endstage kidney failure, cognitive dysfunction, whatever. And you might be able to still continue, but he’s a jalopy. Right. So he’s got a lot of stuff going on and we’re okay with that. Now, still in that one, there’s still a period of subjectivity that I think a lot of vets struggle with. Well, is he that bad? Can we do more? Could we go further? And they may not know the struggles that are going on at home.
Dr. Andy Roark:
Right.
Dr. Mary Gardner:
Why were you late to this podcast, Andy? Because you had to deal with your-
Dr. Andy Roark:
My dog yarked. He yarked upstairs and I had to clean it up and I was late.
Dr. Mary Gardner:
Great.
Dr. Andy Roark:
To the podcast with Mary Gardner. Yep.
Dr. Mary Gardner:
But it’s a lot.
Dr. Andy Roark:
No one knows my struggles.
Dr. Mary Gardner:
No one knows the struggles that go on at home. And if you’ve got a dog that’s incontinent or a cat that’s throwing up all over and they come into the clinic and they look not so bad, we can put our judging hats on. But typically those are the ones that we can wrap our mind around and we’re okay euthanizing a dog or cat with a terminal illness or very old dog or cat with problems. The second type is the non-eminent medical euthanasia. And I think we start to struggle with these because their recently diagnosed, they’re owners are managing it, but they want to say goodbye. So the classic one is a diabetic cat or dog. And the owner doesn’t want to give the meds. They can’t afford the meds. And we know if it’s not managed, it will get bad.
Dr. Andy Roark:
Yeah. Right. I put Cushing’s disease into this a lot-
Dr. Mary Gardner:
100%.
Dr. Andy Roark:
Because it’s an expensive-
Dr. Mary Gardner:
Thank you. Yeah.
Dr. Andy Roark:
Treatment. And the pet’s panting and peeing everywhere. And if the owners are like, “Look, we can’t do this.” And I’m like, “I don’t see how this gets better.” That’s the non-imminent for me. I think I’ve made peace with those. And also, I think that’s a great way to look at it. That totally makes sense. I’m right here with you.
Dr. Mary Gardner:
Yeah. And I’ve had three dogs with Cushing’s. I wish I paid more attention to Dr. Share, because I learned so much just from my own animals and the struggles and the trials, the dosing and da, da, da, da, da. It was a lot and it’s okay to say goodbye to a dog that’s… Are they healthy? They’ve got Cushing’s, but sometimes we don’t see how they will get worse and what they’re going through right now. Right. So I’m also with you. I’m okay. Does it suck sometimes? Yeah. And Cushing’s is almost a little bit easier for us to manage, right?
Dr. Andy Roark:
Yeah.
Dr. Mary Gardner:
Let’s talk about the diabetic cat, right. It’s just a little wee needle. 50 bucks a month.
Dr. Andy Roark:
Well, but I’ve got another one for you. It’s the happy arthritic dog. That one is a dagger in my heart. I hate it so much when they eat, they bright eyed, but they can’t get up, they can’t keep themselves clean, the owner can’t get them down the stairs. And you see their mobility going down and like, oh, that’s the one that just, oh, it bleeds me. That was so hard-
Dr. Mary Gardner:
It breaks my heart too. It breaks my heart too. And those owners, you can’t just say, well, throw a yoga mat around and you’re fine. It’s so much more than that. Right?
Dr. Andy Roark:
Yeah. It’s so much more. And of course the owners are struggling with this so mildly. Anyway, I’m-
Dr. Mary Gardner:
So that’s for-
Dr. Andy Roark:
Knowing imminent-
Dr. Mary Gardner:
Those two, I think imminent and non-imminent. Non-imminent, can be a struggle for some teammates though. And they’re like Dr. Roark, but this cat though, it’s an orange tabby and he’s so cute. We could re-home him. Somebody will take care of a diabetic cat, right? Or a Cushing’s dog. I had a Cushing’s… That whole story.
Dr. Andy Roark:
Yep.
Dr. Mary Gardner:
Then there are two others and the other one is a non-medical euthanasia. So the behavioral issues. And then before we talk more about that, let me jump to the fourth one. Then there’s truly convenience, euthanasia, where I simply do not want this animal anymore and I’m moving. Whatever it may be. We all hear the story, if they don’t match the couch, and that’s going to happen, once, maybe in our lifetime. I doubt any of us are really going to hear those. But those are so rare, Andy, that someone comes to your office and says, “I don’t want this animal anymore.” If that’s their mentality, they’re dumping them off somewhere. They’re putting it at the shelter. I’ve had a lot of people that maybe older pets, maybe 10, let’s say, and they’re like, we’re moving. He’s like, “I can’t take the animal. And I know it’s better to euthanize him than live in a shelter.”
Dr. Mary Gardner:
Now is that convenience? Or everybody will say, “Well, you should only move to a place where you can take your animal.” Right. Well, what if you’re going through a divorce? You’re got no ability. The only apartment that you can find doesn’t take them, or it’s a breed that they don’t take. Whatever the story is, it’s not always easy to move with your animals. So yeah, those are tough, but those are so rare. And I don’t ever do a convenience euthanasia, but I will help. So if I’ve got a dog that is a 12 year old Rottweiler, and they want them euthanized, I’m going to find the Rottweiler rescue in my area or around, and hook them up. Because there are people that will, but you have to be careful when you say no. What the consequences are of saying no.
Dr. Andy Roark:
Well, it’s just, well, yeah. Again, I hate to even bring this up, but we’ve all heard the thing of, if you don’t do it, then I’ll shoot them or something, or it’s been a long time since I’ve heard that, but I’ve heard that more than once in my career. And you go and again, that’s anyway, we could go off on a big tangent on that and I don’t want to, but we’ve all heard those things. And it does make you think through like, well, what are my real options here and what are these outcomes? And that is challenging.
Dr. Mary Gardner:
It is. So now let’s go back to that third one. So behavior. And there’s different types of behavior issues. So there’s untrained animals. So dogs that are just crazy jumping up and a pain in the ass.
Dr. Andy Roark:
Sure. I have one upstairs that matches this description. Yes.
Dr. Mary Gardner:
Yeah. Then there are reactive dogs. So many of us say aggressive dogs. Biting, just lunging, maybe just to certain people, certain situations, another cat in the house, another dog in the house, things like that. I’m going to start this whole conversation with it sucks, but I will euthanize those.
Dr. Andy Roark:
Yeah?
Dr. Mary Gardner:
It has taken me though years to get there without being upset over it, because you go there and sometimes they’re sweet and they’re nice. And you’re like, well, this dog wouldn’t hurt a fly. Yet if that cat mosey out, they would kill him. It’s so interesting behavior, euthanasia. And typically owners, listen, 90% of owners are going to come to us because they’re desperate, they need help. Are there some of those butt head owners that are just like, yes. You can parse those out usually.
Dr. Andy Roark:
Yeah, totally.
Dr. Mary Gardner:
They’re frustrated. They’ve tried stuff. What happens though in our world is what is our immediate response to that? And these people have probably had this, pet for a year or more, and everyone says, “Well, you need to go see a behavioralist. You need to go see a trainer. Have you tried positive reinforcement? Have you tried separating the animals? Da, da, da, da, da, da. Have you tried drugs?” All these things. And that’s a lot. It’s a lot to put on some people. And it I’ve come to realize that behavior is a mental illness. Mental illness is an illness. They’ve got anxiety. They’ve got something that is triggering them. And what helped me with this even better is my current dog. So I’ve always had perfection dogs, all my Dobermans. They’re always awesome. My Samoyed’s great. So when my last Doberman died, I went and got this dog, Noran is his name.
Dr. Andy Roark:
I’m pausing here for a second, because you say you’ve always had awesome Dobermans. And I have to admit that you do have awesome Dobermans. And I know because one of them could have killed me one time when, I don’t know if you remember this, I just, as a side. You had me and Allison, my wife, and some other people over at dinner at your house in Gainesville, Florida. And I left to go do something. I left something in my car. I went away and I came back and I said, I’ll just let myself in because I know they were in there having dinner.
Dr. Andy Roark:
And I open the back door into the mud room and Neo, the Doberman Pinscher, just, he walks into this dark room with his ears sticking straight up. And he just looked at me and I saw the end of my life there and I was going, “Hey, Neo. It’s me, your buddy, Andy. I saw you earlier tonight.” and you overheard and came to save me. But he was an impressive animal. And I’ll never forget letting myself into the dark room and seeing the silhouette shadow, outline of Neo looking at me from the doorway. I was like, oh, I have made a terrible miscalculation, but he was wonderful. So I’m sorry. Go ahead.
Dr. Mary Gardner:
He was wonderful. And he would be protecting of me. So just like many Bichons would. You could just do damage. So I’ve always had very great dogs. So I adopted this dog Noran a couple of years ago and the moment I saw him, I knew he was trouble. He had one blue eye, like the blue eyes just tell you they’re crazy. He got a magic, crazy eye. Right. And I’m like-
Dr. Andy Roark:
I imagine them being different sizes. I know that’s not true. But just, when you said that, it reminds me of, yeah.
Dr. Mary Gardner:
It looks different. So Dennis thought he’d be perfect. And I’m like, that dog’s got issues. I can tell this is behavior, whatever. Luckily we introduced him to my dog, Sam, who was like, Eeyore. Nothing bothers her. She’s 13. Has cancer, dying. She’s no problem. Little did we know, he wanted to kill everything else and so we have a cat. He wanted to kill the cat. Going for walks, he was like a gator. He’s killed rabbits in the house. He’s got anxiety. When we left, he was scratching at the door. It was-
Dr. Andy Roark:
Oh, man.
Dr. Mary Gardner:
Full on behavior problems. And it was so stressful. Every day I’d leave. I’d have my cat in another side of the house. And I’m worried, can he get through the door? I’d have to barricade the door. The stress and anxiety that this dog brought to me was unmeasurable. It was insane. And we were the fourth home.
Dr. Andy Roark:
Oh, wow.
Dr. Mary Gardner:
So it’s not easy to find someone to deal with this. And he was great. Didn’t chew on things. Didn’t poop anywhere. He was a great time, but he had anxiety. So I was lucky enough to afford the cost and the time to go see a behavioralist. And when I say the time, because it’s not just the money, it is time and patience.
Dr. Andy Roark:
And commitment.
Dr. Mary Gardner:
And commitment.
Dr. Andy Roark:
To keep doing it. Yeah.
Dr. Mary Gardner:
It is hard. So we went and saw Lisa Radosta.
Dr. Andy Roark:
Oh, she’s great.
Dr. Mary Gardner:
She’s great.
Dr. Andy Roark:
She’s been on the podcast a couple of times. Yeah. She’s great.
Dr. Mary Gardner:
If she can’t help you, no one can. Right?
Dr. Andy Roark:
Yeah. You’re going to the best. Yeah.
Dr. Mary Gardner:
I’m going to the best. So she’s like, he needs to be on meds. And then of course, Dennis didn’t want him on meds, this whole big thing. And so, and she’s like, yeah. Do positive reinforcement. Leave it, leave it, all this stuff. It was a hell year. I was near euthanasia three times.
Dr. Andy Roark:
Wow.
Dr. Mary Gardner:
It was really bad. The drugs were so helpful, but it’s patience. And I ran out of it a lot of times and the anxiety that if I can’t handle it, no one can. And I know he’s anxious. And she’s like, “It’s reactive. It’s not aggression. It’s react.” So I learned so much, but not everybody can afford that to go see a Lisa Radosta, and us doctors aren’t the best at dealing with behavior. We’ll put them on reconcile, and fingers cross that’s enough. Right. But there’s a lot to this. And so she taught me tips and tricks. So we’re three years in. He’s still alive, but I got to be honest. I wish I could find a home for him that is just him alone, where he could be-
Dr. Andy Roark:
Yeah. Just him.
Dr. Mary Gardner:
Just him. Because my cat has been a prisoner for three years and I can’t get anybody else. Sam is long gone and I can’t get any other pets because of him. And I can’t bring him to the beach. I can’t bring him to a dog park. Walking is a pain. It’s hard. So understanding that now, as bad as it is, I would’ve euthanized him and I would have helped a family do that. But it sucks.
Dr. Andy Roark:
Yeah. That’s really interesting. I had not thought of reactivity as mental illness. And that’s interesting. And so that’s exactly this type of philosophic sort of framework I was looking for. I had not put that together, but yeah. Sort of following those steps is reactivity is often anxiety, fear, things like that, at a pathological level. So mental illness, we know that mental illness is an illness. And at that point I go, okay, well, I’m walking up to this point where we have this pet that’s ill that is not responding to treatment and is negatively impacting, especially to the point where people are getting injured or we’re afraid for the lives of other animals. That’s super helpful.
Dr. Mary Gardner:
And just think, if a family has a Cushing’s dog that doesn’t want to try Trilostane for whatever reason. Are we okay euthanizing them?
Dr. Andy Roark:
Yeah. That’s exactly what we were talking about before, is I’m like, yeah. We know where this is going and yeah. We’re okay with it.
Dr. Mary Gardner:
We’re okay with it. What about if a family doesn’t want to do reconcile and training and all, and behavior and things like that. I mean, it’s a commitment and they don’t have the time, energy, emotional capacity, finances to do it. Reconcile is not free. Right. So I’m okay doing it. It’s hard though. Now there are some true Cujo’s out there that are just aggressive.
Dr. Andy Roark:
Oh, yeah. There are some that you just go, they’re terrifying. And you say, oh, I-
Dr. Mary Gardner:
Correct.
Dr. Andy Roark:
I see this as a benefit to society. It’s good for the dog. Someone’s going to get badly hurt here.
Dr. Mary Gardner:
Yes. And I think we all know it. Right. So I think those are easier for us to do. It’s the Noran’s out there that have a history that, and he’s bitten a few people and so he’s on the list. And I can’t travel. Oh, guess what? Going anywhere, I got to find a boarding facility that could specially handle him and now I worry about him hurting other dogs. And it’s intense and it takes a lot. So if any listeners would a monogamous relationship with a pointer mix, female. DM me.
Dr. Andy Roark:
Yeah. If you live on a farm somewhere, you don’t want people to come visit you.
Dr. Mary Gardner:
He’s perfect.
Dr. Andy Roark:
We got you. Yeah. If you’re like, I’m done with people, we can help you make that a more permanent state.
Dr. Mary Gardner:
Right. But he is great. So these are tough. And we do about, I think it’s about 2% of the families that we help at Lap of Love. And we help over 100,000 a year. So it’s a lot, but 2% is behavior euthanasia.
Dr. Andy Roark:
Yeah. Wow.
Dr. Mary Gardner:
And it’s on the spectrum of Cujo’s to a Noran and a lot of our vets struggle with it. And our biggest key is you got to go talk to the family.
Dr. Andy Roark:
Yes.
Dr. Mary Gardner:
You can’t say no until you talk to that family and you sit in their house and you see their fear or you sit in the clinic and talk to them, feel their frustration and understand it. And if they are just those few percent that are flip it and silly, you don’t have to, but understand what no means.
Dr. Andy Roark:
Yeah. That’s really good advice. I really appreciate that. Hey guys, I just want to jump in here real fast and give a shout out to Banfield the pet hospital for making our transcripts available. That’s right. We have transcripts for, The Cone of Shame podcast and the Uncharted Veterinary podcast. You can find them at drandyroark.com and at unchartedvet.com. This is part of their effort to increase inclusivity and accessibility in vet medicine. We couldn’t do it without them. I got to say, thanks. Thanks for making the content that we put out more available to our colleagues. Guys, that’s all I got this time. Let’s get back into this. So let me jump back here a little bit and say we talked.
Dr. Andy Roark:
So I talked about that at the very top about economic euthanasia and talked about when we have someone who says, oh I can’t afford this service or things like that. And I know these are different waters, but I think that what we just talked about with behavioral and reactivity, I think that was really helpful for me. And you’ve clearly thought these sort of things through. Do you have thoughts on how economic euthanasias, the impact that they have on doctors or their mental checklist that you run through in that regard?
Dr. Mary Gardner:
It’s tough because you’ll hear people all the time say, if you can’t afford the animal, you shouldn’t get one. Right.
Dr. Andy Roark:
Oh, man. Yeah.
Dr. Mary Gardner:
Which I can’t stand that actually, because I think we would have a lot more people with animals in the shelter, if that was-
Dr. Andy Roark:
Okay. So hold on. This is really interesting. Okay. So I’ve been thinking a lot about this in the last couple of days and weeks, because I have seen a resurgence of this comment of if you don’t want animal, or if you can’t afford an animal, you shouldn’t have it. Okay. And people go, well, I can’t believe anyone would say that. And of course, I don’t believe in that. And I think that lacks empathy when we say it, and I understand why doctors say it. It’s because we’re frustrated and we want to not feel we’re the bad guys.
Dr. Andy Roark:
And so, we like to sort of shift the blame and say, how dare you get mad at me. You’re the one who has this responsibility that you’re struggling to pay with. Why do I feel terrible? I didn’t have anything to do with this. And it’s funny because there’s this balance, right? There’s the, if you can’t afford a pet, you shouldn’t have one. And I think most of us go, oh, that’s not good. But if I flip it around and say, do you believe that we have a responsibility to take care of pets that we take on? I think most of us would say, yes, we do have that.
Dr. Mary Gardner:
Yes. But where is that line though? Why-
Dr. Andy Roark:
And that’s the interesting part.
Dr. Mary Gardner:
Yes.
Dr. Andy Roark:
Yeah. So anyway, I’ve been thinking a lot about that.
Dr. Mary Gardner:
Okay, good. So it’s shelter, it’s love, it’s food and water, right? That’s the basics that we all have to be able to give or else you shouldn’t have that animal. Yeah. Do we have to, what if they can’t afford? I mean, and heartworm prevention, maybe vaccinate, some very basic care. But if they can’t afford the Trilostane or they can’t afford… $50 to some people is a lot. Right.
Dr. Andy Roark:
Yeah.
Dr. Mary Gardner:
So I think you probably sat in my lectures once when I would be like, who’s got 1,000 bucks that could just hang out with me for the weekend. Right?
Dr. Andy Roark:
Yeah. Just plop it down.
Dr. Mary Gardner:
Just plop it down. We could just go hang out. And like, nobody raised their hand. And I said, well, that’s what a sick animal, for figuring out what’s wrong with them, getting them to do x-ray’s or whatever, is 1,000 bucks. 51% of the population of America do not have over 1,000 dollars in savings. They don’t have it. And should we say Care Credit and credit cards and stuff like that? Well, that’s debt and now we’re adding more debt. Okay. So I think for us just to say, if you can’t afford more than the basics, you shouldn’t own an animal. That would be great if we had a lack of animals in the world. Right.
Dr. Andy Roark:
Right. Oh, yeah.
Dr. Mary Gardner:
So only if you can afford 500 a month then you should. We are overpopulated, they’re out there. They’re needed. So we need homes for them. What’s the line though.
Dr. Andy Roark:
Well, and that’s funny too. So hold on. Let me throw another story in here as well. So I got a chance to interview the gang who was at the main veterinary emergency center that had this terrible sort of cyber bullying thing not long ago. And so, yeah. So basically, they had a patient that came in and it was a young pet and it needed surgery in a bad way. It had eaten a skewer.
Dr. Mary Gardner:
Yes, that’s right.
Dr. Andy Roark:
A wooden skewer and the story was basically this thing had done horrific internal damage.
Dr. Mary Gardner:
Per the lungs.
Dr. Andy Roark:
Exactly right. Perf the stomach, skewered the liver into the-
Dr. Mary Gardner:
It was a skewer.
Dr. Andy Roark:
Yeah. It’s skewer. Yeah.
Dr. Mary Gardner:
It was skewered.
Dr. Andy Roark:
Yeah. It did what it was made to do, but and it’s got pyothorax, it’s sepsis from a leaky abdomen. It was a $10,000 surgery minimum to fix this pet going in and you might have $1,000 laying around, you might have $5,000 laying around. There’s not a lot of us that have $10,000. And so even to me, and as I think about where is this line, I’m going, and it’s just an interesting question. Do I feel differently about a pet that needs a $3,000 surgery, and a pet that needs a $10,000 surgery?
Dr. Mary Gardner:
What’s the like?
Dr. Andy Roark:
One of them seems farther from, we can just do this and make this happen then the other one does, is like, is there a difference in saying your pet needs a $500 procedure versus your pet needs a $5,000 procedure? And that changes how I feel about this? These are all questions-
Dr. Mary Gardner:
It’s deep. Right?
Dr. Andy Roark:
I’m asking myself. Yeah. It really is. But if we didn’t used to have $10,000 procedures, Mary. When you and I came out of vet school, that was unheard of.
Dr. Mary Gardner:
Unheard of.
Dr. Andy Roark:
I remember the first time I heard someone say, “These people spent $10,000 on this pet.” And I was like, oh my God.
Dr. Mary Gardner:
Right. What? And I actually have friends of mine in school… They had a Doberman that came to the clinic. It had 30% body burns. And of course, everyone knew I loved Dobermans. So Mary got the case and it was two months in the clinic. They spent $20,000, something crazy like that. And I remember asking them like, “It’s okay to say no, it’s okay.” And they were like, “We’ll make more money, but this is our dog.” And I’m like, okay. But its okay also if they said no, and where is that? Where is that line? And I can go deep on, like, I don’t even know what the answer is.
Dr. Andy Roark:
Totally.
Dr. Mary Gardner:
And I think that’s the point is there isn’t an answer. I think I get upset if someone pays money for their dog, they pay $2,000 for a freaking Yorkie or whatever, and then they can’t afford a $2,000 surgery. I think that’s where Mary’s like, that’s where my line is. If you adopted a dog for 150 bucks and you gave it a couple of years of great life and food and kibble, whatever, and now all of a sudden you can’t afford a $500 block. Oh, I’m okay. I get it. I’m okay.
Dr. Andy Roark:
Yeah. That dog got five years of life that a lot of other dogs in the shelter or that don’t make it in the shelter would not have gotten, and they go, okay. It’s funny. Yes. That dog didn’t get the life it would have if it was in a home where there were people who had a bajillion dollars laying around, but most of us are in that home. And I mean, and you sort of say, well, I don’t know. It’s just, it’s really interesting to sort of say, where is that line where you say, this is what I could do. And I took care of this dog in a health state. And the fact that this dog could theoretically live on if I had $12,000 to spend on surgery, that doesn’t matter because I don’t have $12,000 and I shouldn’t feel bad about it. And the people who do have $12,000, they shouldn’t feel bad about it either. But I don’t want to hold those… Those two people are different.
Dr. Mary Gardner:
Just because we can doesn’t mean we should. Right.
Dr. Andy Roark:
Yeah.
Dr. Mary Gardner:
You know what’s so interesting too is I’ve done so much for my animals. And so many veterinarians have said to me, like, “That seems excessive. You did radiation, chemo, and da, da, da, da, da, da, da.” So it’s interesting, because I’m like, well, what if I didn’t do it? Would you judge me then too?
Dr. Andy Roark:
Oh, yeah.
Dr. Mary Gardner:
Right. And you get a person in the family that’s like, I don’t want to put my cat through chemo with lymphoma. Well, they actually have a really good response rate to it. Well, I don’t want to put them through that. But then you do put a cat in chemo and people are judging you then too. Like, what are you doing to that cat? It’s just a cat. You can’t win.
Dr. Andy Roark:
Yeah. You can’t win. You can’t win. That’s true. Yeah. It’s true. It is true.
Dr. Mary Gardner:
It’s just crazy. Now, let me let talk about this peeing cat that you talked.
Dr. Andy Roark:
Okay. Yeah. Let’s talk.
Dr. Mary Gardner:
And who here wants to get that? This is all over their house. No one.
Dr. Andy Roark:
No.
Dr. Mary Gardner:
No one wants that. Right. That’s a huge issue. So I want to read something to you, but before I do, I remember you sat in my lecture and I think it was this lecture I do on like, what would you do? And I go over seven cases from the urinater to the untrained dog, to the reactive dog, to the arthritic, but still okay dog. So we just go through cases. I think I’m doing it again at BMX. And it’s just a good interactive. Anyway, so you came up after me afterwards and you were just like, we put so much pressure on our staff sometimes that we don’t realize that, okay. Mary loves Dobermans. So guess what?
Dr. Mary Gardner:
We’ve got the diabetic Doberman that came in, guess who’s getting a phone call to adopt this dog? And the guilt we place on each other, we have to careful on. Because we’ve got staff members that have got 12 cats at home because they can’t say no. And I think it is really good to have this open conversation with the team to say, where are our lines? And don’t judge somebody. If Mary’s okay euthanizing a reactive dog, don’t judge her. This is why she thinks this way. So I found this on a Facebook group. And it was a veterinarian talking about this pet. I don’t know if it’s dog or cat.
Dr. Mary Gardner:
I’ll see in a second, but she said, “She is peeing on things randomly. Pillows, on my bed, her bed, the carpet, et cetera. I’m at the end of my ropes. I didn’t want a dog when I adopted her, but I was guilted into taking her on by my coworkers at my old job. I’m so frustrated. She’s really a sweet dog, but she has something bad and it makes her hard to re home and I can’t really afford to just do every test there is with no guarantee that we’ll find out what’s wrong and treating it.” A cat or dog that’s peeing, especially a dog, there’s something wrong. It’s probably not just training. Right?
Dr. Andy Roark:
Yeah.
Dr. Mary Gardner:
That to me is a medical issue. And if we can’t figure it out, it’s like, I’m okay. Do I want to figure it out? Yes. But we can’t. And our good friend, Megan Brashirs, who I just adore her.
Dr. Andy Roark:
Yeah. She’s amazing.
Dr. Mary Gardner:
She’s said a quote once. Do not shoulder the responsibility of the health and safety of every animal in this world.
Dr. Andy Roark:
I know people who should have that tattooed on their body.
Dr. Mary Gardner:
Right. This should be in a clinic everywhere. Do not shoulder the responsibility, the health and safety of every animal in the world. We do what we can. And so when I’m lecturing on euthanasia, I say, I can’t always be in control of why, but I can be in control of how, and I will do a really good euthanasia. I will make sure that pet… And it sucks, because sometimes I want to take them all. I want to take all the Dobermans and the orange cats and the black cats and I can handle it, but I can’t also. I can’t do it. And I have to pillow my head at night and I just, I don’t take on the guilt that’s not mine.
Dr. Andy Roark:
Yeah. I agree with that. I think it’s funny. I’ve been thinking a lot more about, and I don’t know if we’re really going to go this way. I think I would say the future of vet medicine is fragmentation. And I look a lot at you and Mary and what you’ve done, or you and Danny and what you guys have done with Lap of Love as one of the key pieces of that early on in my career, that’s all. When I say that the future of vet medicine is fragmentation, what I mean is I think we’re all going to do different things before long. Meaning there will be pet hospice. Some of us will just do recovery and rehabilitation. There will be the mega boujee 24-7 places. And then there’ll be the concierge vets who don’t have an office.
Dr. Andy Roark:
They just go to people’s houses. I think there’s going to be some low cost, high volume places, and some low volume, high cost places. And that’s not bad, because then people can sort to where they want to be. And we can get support for people who need it and financially and things that. I think that’s all good. But it’s just, as I start to think about medicine, where we’re going, especially recession, things like that. I do wonder at some point, if we need to look more at almost shelter medicine and start to think, at what point do we start to think of ourselves doing herd health, almost where you say, I can’t fix all the pets and I need to own that I can’t fix all the pets.
Dr. Andy Roark:
I have a flock who are my clients, pets, who I try to take care of and I need to maintain myself so that I can keep going. But part of the herd health is to say, some of these pets, we’re not going to be able to save them all. And the goal is not to save them. All the goal is to look at all the good that I do and all the work that I do and achieve the optimal outcome, not the maximum outcomes in every case. And it’s an interesting philosophy, but you have to switch away from eye to eye contact with the pet owner in the room and switch it more to looking at everything that I do and my career, and how I’m going to have boundaries and sleep at night and not burn out.
Dr. Mary Gardner:
100%. That is so well said. And you know what? It’s okay to remember some things, right. I remember Deedee, the very aggressive Rottweiler that wanted to kill me, but and I just used that, but you know what was great about Deedee, it was peaceful. It was good. I still did it well. Could it have been different? Yeah. But you’re right. The net result of all that we do is so good that, do not let these lived stories in your mind that you can’t then escape from, and it’s tough. These are our very difficult decisions and we love animals. That’s why I became a vet. I love animals. I’ll say it. Right.
Dr. Andy Roark:
Yeah. Oh, yeah.
Dr. Mary Gardner:
And I love the families that love them too, but we can’t be everything.
Dr. Andy Roark:
We can’t, we can’t. I’ve got this idea. I tried to write it one time and I think it bombed, I don’t think it’s funny. Either no one read it or they read it and they were kind enough to not mention it to me, but I got this idea. I call it the paradox of the special pet is the idea. And so in order to be in vet medicine, right, you have to be able to hold these two conflicting views in your head at the same time, I think. So here it is. All right. So the paradox of the special pet, you have to be able to look at a pet and realize that, that pet is the center of the world for that person, right. They are a special pet. And then at the same time, in order to keep your brain and not burn out, you have to also be able to look at that pet and know that there are an endless number of other pets out there in the world that need care, that need homes, that would be wonderful for any of us to have.
Dr. Andy Roark:
And so that pet is not special, because there’s a million other pets. And also, pets don’t live very long. In the best case circumstances, they don’t live very long. And so we have to be able to look at two completely contradictory views. One being every pet is deeply special and every single pet is not deeply special because there is an unending stream of sick pets and well pets that need homes. And we are looking at one little drop of water in the ocean. And I think that if you can hold both of those things in your head at the same time, you can be happy in vet medicine. I think so. And if you can’t hold them both in your mind, I think that one way or another, you’re going to have pain that you’re going to have to figure how to manage.
Dr. Mary Gardner:
Yeah. No, I would’ve read that and said, “Bravo, my friend.”
Dr. Andy Roark:
Oh, well, thank you very much.
Dr. Mary Gardner:
Because I think it’s good. And look how we started talking about my dog, Noran, and I said, I can’t get any other animals. I would adopt five more animals right now. I can’t because of him. Right? I can’t and there are so many out there and I think we could do probably… I think it would be very helpful to talk to other industries like child services, right? Those people who work in child services, how horrible is their job to see children that they have to leave in a house that they’re abused and stuff. Their minds must be so bad too.
Dr. Andy Roark:
Oh, man. We’ve gone through this thing in the last couple of years and people were talking about vet medicine is horrible, and vet medicine is uniquely challenging. It is a hard profession and we both know it. And burnout is a real problem. And mental health and wellness is a real problem. I don’t believe that we own the market on unhappiness, on stress, on emotional burnout. Because I have two friends that are in DSS and I don’t know how you go and take kids away from their families, or how you go and not take kids away from their families, given some of the things that these people see. I don’t know how you do it. I have a friend who is a pediatric palliative care specialist. She manages pain in children with cancer and other illness. And I’m like, I’m sorry, buddy. I don’t know that I would ever have the emotional fortitude-
Dr. Mary Gardner:
Me too.
Dr. Andy Roark:
And I’m, yeah, exactly. To do what you do. And I do fairly well with this, but I’m like, I just, I don’t know how other people do it. So I think that there’s lots of other people.
Dr. Mary Gardner:
Yeah. Right. We don’t have the market on anxiety. There’s a lot out there and I think we could learn a lot from how people manage some of these stresses and emotional tug of wars in their hearts.
Dr. Andy Roark:
Yeah. Yeah. I agree. I think we’re going to keep learning. And I think that there will… I do. I think as a society, I think we’re going to keep learning. I think there’s a lot of focus on anxiety and stress just in general. And I’m optimistic about the future. I really am. I don’t want people to think that I’m down. This is a hard part of our job that’s never going away, but it can be less hard. And I really do think that remembering your, why, matters a lot. We’re doing this because we believe it’s the right thing to do and this is part of delivering a good death is part of a good life. It really is. And protecting from suffering I think is often one of the kindest things that you can possibly do. Dr. Mary Gardner, thank you so much for being here. Your book is out. We talked about it last time we were here. Run me down on the title of your book again.
Dr. Mary Gardner:
It’s called, It’s Never Long Enough: A Practical Guide to Caring for Your Geriatric Dog.
Dr. Andy Roark:
Yes. If you guys enjoyed this conversation, check out Mary’s book. We also have a podcast episode from when it came out. You can listen more about that and hear more of me talking with Dr. Mary Gardner. Mary, where can people learn more about, Lap of Love? Where can they find you online?
Dr. Mary Gardner:
Yeah. So Lap of Love is just lapoflove.com, which has got a lot of great resources also for veterinarians on our sedation protocols and things like that. And then, or just my website, which is D-R, Mary Gardner.
Dr. Andy Roark:
All right, gang. Take care, everybody.
Dr. Mary Gardner:
Bye.
Dr. Andy Roark:
And that’s our episode guys. That’s what I got for you. I hope you enjoyed it. I hope you got something out of it. As always, I love an honest review wherever you get your podcast. If you’re watching this on YouTube, hit that subscribe button and tune in more often. Gang, take care of yourselves. Be well. Talk to you later. Bye.
